After years of uneven adoption, value-based care (VBC) is gaining momentum as providers and payers seek to improve patient outcomes while controlling out-of-control health care spending in the US An overwhelming 94% of health system executives Expected Value-based contracts will continue to grow in the coming years.
However, for VBC to work, healthcare stakeholders need to be able to compensate for the services of all participants in the VBC network. This is where the challenge lies.
The VBC network must first have an infrastructure to ensure that data can be shared by upstream and downstream participants, which may require technological investment to release traditionally isolated data and capabilities. Second, the VBC network needs to adapt to a variety of evolving payment methods that belong to the VBC label. Each method may have different incentives, performance indicators, and expenditures. The scope currently includes risk-sharing arrangements, such as responsible medical organizations (ACOs), bundled payment plans, full and partial per capita charges, and medical insurance shared savings plans with upside and downside risks.
Finally, providers and payers, those who bear financial risks, are increasingly aware that the social determinants of health (SDoH) play a huge role in health outcomes and health care cost management. The VBC network must be able to integrate non-medical and community organizations (CBOs) so that they can share SDoH and other data, provide services, and play a role in joint care coordination programs. However, many CBOs have tight budgets and have not prioritized investment in digital technology.
Enter the need for value-based management (VBA).
The role of value management
Existing claims and legacy technology investments based on clinical workflows, whether in terms of payers or providers, cannot effectively manage value-based arrangements on a large scale. They lack the ability to manage a complex care network involving multiple stakeholders in multiple roles, and they cannot meet the requirements of the rapidly evolving value-based payment model. Instead, what is needed is the ability to expand those critical legacy systems. VBA encapsulates the purposeful and flexible hierarchical partner model, digital-based data capture, and the data sharing functions required to execute on value-based programs.
VBA enables the VBC network to promote holistic care by coordinating the provision of resources and services for medical and non-medical care at the same time, so as to improve the effectiveness of patient treatment and reduce the resulting health care costs. When fully deployed, VBA spans all care environments (site-based, virtual, at home and in the community), from data capture and data sharing all the way to payment-and all on a large scale.
Although many healthcare stakeholders have relied on data analysis and digital tools for network management, care coordination, and care provision, these are usually point solutions that will eventually create islands of information that are difficult to share, leading to inefficiencies that affect results and costs . But given the massive investments that stakeholders have made in legacy IT infrastructure over the decades, few people are willing to dismantle it all and start over. However, such systems and workflows are either unmanageable or unable to extend these arrangements.
Although recently announcement According to the trend of simplification of payment models indicated by the Center for Medicare and Medicaid Services, the current reality is that stakeholders in the entire healthcare industry are operating under a series of service fees (FFS) and value-based payment models. These range from direct FFS, to FFS that encourages narrowing the care gap, to common up and down risks (or both), to all or part of the headcount of downstream partners.There is a blank paper Publish It was stated earlier this year that FFS “has nothing to do with quality or value, and still accounts for nearly 40% of all insurance company payments, as well as most of the payments for Medicaid and commercial insurance.”
In addition to managing multiple payment models, vendors and payers are now dealing with the reality-caused by the Covid-19 pandemic-they must address health inequalities in our care system, which makes SDoH data useful for identifying housing, etc. Factors are critical. Safety, convenient transportation and income levels have exacerbated health inequalities. The VBA approach enables providers and payers to collaborate with CBOs in the VBC network to share information, coordinate patient care plans, and perform specific services—making all partners, medical and non-medical/CBOs in the VBC network responsible for delivering their expectations.
What VBA looks like in practice
After successful implementation, VBA will coordinate the “many-to-many” relationship between VBC stakeholders and their ecosystem attributes to achieve information capture and sharing, necessary B2B and B2C multi-channel communication, and fully implement the requirements of upstream and downstream partners Financial arrangements. These may include:
- Health insurance company
- Risk-taking entities (such as ACO, clinical integration network, and divestiture plan for chronic disease management)
- Primary health care
- Nursing management program
- Social service network
- Community service agency
One of the core capabilities of the VBA approach is the upstream capture of capital pools and downstream allocation to VBC network partners-doing so is consistent with the wide range of payment models that are working within a given network. This is an example: After recording the post-visit status report required by the patient, transfer the money to the home dialysis provider for full payment, and at the same time pay the Meals on Wheels community provider after receiving the confirmation of the delivery of the meal from the same patient . The diversified high-performance network enables medical and non-medical resources to use the same technological track to play their respective roles in diversified care plans. This is value-this is management.
in conclusion
Value-based care is using a holistic, proactive approach to change healthcare that takes into account the social determinants of health and takes advantage of the integration of services provided by community organizations. In order to effectively implement VBC, payers and providers must manage the complex contractual relationships between network partners in a way that ensures that all participants are paid. The focus on VBA is a key driving factor in achieving this goal.
Photo: atibodyphoto, Getty Images
